AB0541 NEUROPSYCHIATRIC MANIFESTATIONS IN SYSTEMIC LUPUS ERYTHEMATOSUS: PREVALENCE, MANAGEMENT AND ASSOCIATED FACTORS
Authors: M. Ardhaoui, M. Brahem, S. Arfa, R. Grassa, B. Ben Rejeb, H. Hachfi, O. Berriche, Y. Mohamed
Journal: Annals of the Rheumatic Diseases (2022)

Background Neuropsychiatric involvement is one of the major causes of morbidity and mortality in systemic lupus erythematosus (SLE). Its prevalence varies in the literature because of its clinical polymorphism. Objectives The aim of our study is to evaluate the clinical, biological, immunological and therapeutic characteristics of neuropsychiatric complications and to analyze the associated factors. Methods This is a retrospective descriptive study including patients followed for SLE (ACR 1997/ SLICC 2012) during the period between 2010 and 2021 at the Rheumatology and Internal Medicine departments in Mahdia, Tunisia. Results Our study included 82 SLE patients among whom 29 had neuropsychiatric manifestations (NPM) with a frequency of 35.4%. They were 28 women and 1 man. Their mean age was 52.41 ± 18.11 years [21 - 85]. The mean disease duration was 2.4 ± 3 years [15 days-15 years]. The mean SLEDAI was 9.3 ± 7.85 [0-32]. NPM were inaugural of SLE in 14 cases (17%). Central neurological manifestations consisted of cerebral vasculitis (n=11), epiletic seizures (n=1), ischemic stroke (n=1), aseptic meningitis (n=1) and transverse myelitis (n=1). Peripheral neurological manifestations of mono/polyneuropathy were found in 6 cases. Cranial nerves involvement was described in 2 cases (Optic neuropathy and vestibular nerve damage). Psychiatric manifestations were present in 7 cases (25%): Depression in 4 cases and psychosis in 3 cases. The most frequent associated clinical manifestations were: musculoskeletal (100%), dermatological (89.7%), hematological (72.5%) and cardiovascular (24.1%). Biological findings included: leucopenia (31%), lymphopenia (44.8%), anemia (44.8%) and biological inflammatory syndrome (41.4%). The mean sedimentation rate (ESR) was 53.75 ±34 mm [2-130]. The mean C-reactive Protein was 13.6 ±27.8 mg/dL [0-130]. Anti-nuclear antibodies and anti-DNA were positive in 100% and 41.4% of cases, respectively. Anti-Sm antibodies were positive in 13.5%, anti-SSA in 24.1% and anti-SSB in 13.8% of cases. Antiphospholipid was positive in 8 patients. C3 and C4 consumption was found in 20.7% and 27.6% of cases, respectively. Brain magnetic resonance imaging showed T2 white matter hyperintensities, particularly in the periventricular area, in 8 cases and ischemic brain lesions in 2 cases. The treatment of NPM required: Glucocorticoids (75.9%), Azathioprine (AZT) (24.1%), Cyclophosphamide (13.7%), Mycophenolate Mofetil (3.4%), anticoagulants and antiplatelet agents (40%). The evolution was favorable for our patients except for one patient who developed AZT-induced hepatotoxicity. Statistical analysis showed that NPM were significantly correlated with older age (p=0.003), hematological involvement (p=0.02), lymphopenia (p=0.004), ESR (p=0.01), anti-Sm antibodies (p=0.03) and SLEDAI score (p=0.008). Conclusion NPM during SLE are a serious complication of the disease. Our study shows the frequency and variety of neuropsychiatric presentations during SLE. They must be systematically sought, especially if the disease is active, with older patients and anti-Sm antibodies positivity. Disclosure of Interests None declared